PEDIA NURSING MMSU

1. A nurse in a pediatric clinic helps in caring for children of various ages. In

assessing children, she should remember that (Select all that apply)
• children grow at their own pace following cephalocaudal pattern.
• children pass through predictable stages and new skills tend to
predominate.
• development is continuous throughout life with asynchronous growth
of body parts.
• If a child has passed the optimum time of learning a new skill, he
will not be able to learn the task later on.

Answer: ABC

PEDIATRIC NURSING
• FOCUS - children and their families
• Philosophy: Family Centered Approach
• Goal: Promotive, preventive (lesser haspiralization → better nearn)
curative, restorative and rehabilitation
• Framework:
⁃ Nursing Process
⁃ Nursing theories
⁃ Evidenced - base approach
⁃ Example Umbulical cord - increase risk or predisposition
to infection which is tetanus (less 02 environment: allow growth) Management:
disinfection isoprotyl alcohol

PRINCIPLES OF GROWTH AND DEVELOPMENT

1. G&D are continuous, orderly, sequential processes.
Continuous - at all times, a person is growing new cells and learning new skills
Orderly, Sequential - G&D follows a pattern:
• Cephalocaudal
• Proximodistal
• Gross to Refined
• General to Specific

2. Each child grows at his/her own rate passing through predictable

stages.
3. Different body parts have asynchronous growth.
4. Each developmental stage has its own characteristics.
5. There is also an optimum time for initiation of learning and new skills
tend to predominate
• Learning would come easy and quickly if child is ready.
• If child has passed the target time, he/she may have difficulty
learning the task later on

2. Which of the following statements is TRUE about the roles that pediatric nurses
can take in practice?
• Nurses in the advocate role will prepare children and families for
procedure, surgery, or the hospitalization experience itself.
• Researchers inform patients and families of their rights and options
as well as the consequences of their actions.
• Caregivers diagnose and monitor patients, administer therapeutic
interventions and regimens, ensure quality healthcare practices, and rapidly manage
rapidly changing situations.
• Educators identify clinical practice questions needing answers,
examine the literature for answers to these questions, and then determine whether
or not those answers are appropriate for practice.
Answer: C

ROLES OF THE PEDIATRIC NURSE

• Caregiver - diagnose and monitor patients, administer therapeutic
interventions and regimens, ensure quality healthcare practices, and rapidly manage
rapidly changing situations
• Leader/Manager - supervise and evaluate performance of ancillary
workers and other nurses
• Educator - prepare children and families for procedure, surgery, or the
hospitalization experience itself
• Advocate - inform patients and families of their rights and options
as well as the consequences of their actions
• Researcher - identify clinical practice questions needing answers,
examine the literature for answers to these questions, and then determine whether
or not those answers are appropriate for practice

REMEBER: The primary roles are the CLEAR roles

3. Which of the following statements is INCORRECT about MMDST?

• Questions that suggest answers are used to encourage participation.
• The test should be administered prior to any upsetting medical
procedure.
• The test permits those with suspicious findings to be referred as
early as possible
• The test can be performed to both sick and well children as part of the
assessment.

Answer: A (Not Suggested answers, let the child choose the answers, give time to
answer) Screening test: secondary level of prevention

Denver Developmental Screening test (DDST)

Simply RECALL your concepts in MMDST...

FOUR AREAS
• Gross Motor
• Fine MotorAdaptive
• Language
• Personal-Social

FOUR SCORES
⁃ Pass
⁃ Fail (2 or more sectors)
⁃ Refuse
⁃ NO : no opportunity like riding bicycle

• Left of the age line expected to accomplish if not there is still time
for the child to master the task
• Right of the age line expected not to accomplish if yes advance

4. Which of the following activities would the nurse NOT expect a 4-month-old
infant to perform?
• grasps a rattle when offered
• sits without support
• turns head from either side
• responds to pleasure with smile

Answer: B (done by 8 moths)

5. A nurse discusses the motor skills of a 7-month-old infant with the mother. The
nurse explains that the infant will MOST LIKELY be able to
• stand while holding on to furniture (11 months)
• eat with a spoon
• sits alone using hands for support
• walk with support (12 months)

Answer: C - new skill tend to predominate

6. The nurse explains that an infant when allowed to suck on a propped bottle of
formula predisposes him to
• obesity - not indicated in the question
• aspiration -
• oral fixation -
• strong bottle attachment - no bottle attachment indicated in the
question

Answer: B - propped bottle allowing the baby/ left drinking milk

7. The nurse finds out that an infant is competent in the following skills: laughs
out loud - 4 , grasps at an object and takes it to her mouth - , can turn head from
side to side - 3, and drinks from a cup - 8. The nurse correctly assesses that the
infant's age is
A. 2 months
B. 4 months
C. 6 months
D. 8 months

Answer: D - highest level or task achieved

8. A term neonate measured 54 cms. long at birth. What should be the approximate
length when he is 1 year old?
A. 40
B. 60
C. 80
D. 100

Answer: C - 54 + 9 inches (2.5 cm) or 54 + (50%)

• Height - measured in inches ft and cm

• 1 inch (2.5 cm) per month for the 1st 6 months (total 6 inches)
• 2nd 6 months height increase 1/2 inch per month (+3 total of 9 inches =
22.5 cm)
• other books 50% average increase of height

9. A mother verbalizes that she wants to start feeding her 5-month-old child with
solid foods. The nurse should teach her cues for readiness which include any of the
following EXCEPT
A. the child can at least sit with support -6 months (to prevent aspiration)
B. the child can already gesture that she is hungry
C. primitive reflexes such as sucking and rooting are fading - correct cues for
eating
D. there is maturation of the digestive system as indicated by salivation

Answer: B - cannot show gestures that she/he is hungry

4-6 months solid foods introduced

Are you Ready for Solid Food?

Yes, I'm READy! FELLOW! (Guidelines)
Reflexes fading Feed when hungry
Erect - sits with support Eat in small amount (1 tsp)
Asks for more BM/FM Limit to 1 food at a time
Developed enzymes Let child practice
Offer before BF/FF
Wait 4-7 days
Yes, I know the Sequence!
Cereals Certified
Vegetables Virgins
Fruits Fight for
Juices Just
Meats Marriage before
Finger Foods Frying the
Egg yolks Egg!

10. A 3-year-old child is brought to the clinic for check-up. The nurse would
expect that the child will be least skilled in
A. riding a tricycle
B. tying a shoelace - 4 months
C. copying a circle
D. standing on one foot

Answer: B - 4 years and skillful at 5 years

Terrific THREES
• Toddlerhood, Toilet Training, Temper-tantrum
• He/She/He differentiation, Holds crayon
• Refined motor skills, Rides on 3cycle
• Enunciates 2-3 words
• Expresses name, one color
• Stands on one foot, Step-one jump

Tumultuous TWO, TOO, TOP

• Thirty Words
• Words of 2 in a sentence
• Opens doors

• Two feet in place (jumping)

• One-foot balance
• One foot after the other (walking upstairs)

• Takes off clothes

• One-hand hold (glass & cup)
• Parallel play with Pre-operational thought: (playing along but not
with) have their own toys to prevent fight (ex: mother puts lipstick think that mom
is going out) need to tell the baby

11. Which of the following nursing diagnoses can the nurse use in teaching the
mother of a toddler about safety issues?
A. Knowledge Deficit
B. Altered growth and development
C Potential for Accident
D. Altered Thought Process

Answer: A knowledge deficit

12. A mother expresses that her 4-year-old child is always in motion and constantly
drops and spills things. The most appropriate response of the nurse is to
 • determine if sibling rivalry exists
• explore the possibility that the child is being abused
• Explain that this is not an unusual behavior at this time
• suggest that the child be assessed by a pediatric neurologist
Answer: C

13. A mother asks about the dental care of her child. She says that she helps her
child brush her teeth daily. The most appropriate response for the nurse is
A. "Don't worry; your child doesn't need to see a dentist until school age."
B. "Please visit the dentist when your child's permanent teeth start to erupt."
C. "There is really no need to see a dentist now since you supervise her in
brushing her teeth."
D. "Even if there is no noticeable problem in your child's teeth, a dental checkup
is a good idea."

Answer: D

14. The nurse must explain to parents that one of the most effective strategies in
teaching 4-year-olds about safety is
A. show them pictures of children who have been involved in accidents
B. tell them they are bad when they do something dangerous
C. keep all potential hazards out of children's reach
D. provide good examples of safe behavior

Answer: D
Schoolage - great imitators of great behaviours

15. A parent asks the nurse how she can nurture her child's emotional intelligence
through her parenting style. The nurse's response is based on the knowledge that
A. parents should focus on the cognitive milestone of their children especially
when they begin school life. - not only cognitive
B. parents should be strict about rules they set and children should comply with
their expectations - authoritarian
C. parents should set firm and clear limits without controlling their children
D. parents should allow children to grow at their own pace and interest -
permissive

Answer: C

Parenting Styles:
• Authoritarian- focus on obidience
• punishment over discipline
• Authoritative - faciliate positive relationship and enforce rules
• Permissive - do not enforce rules kids will be kids "kunsintidor"
• Uninvolved - Provide little guidance, neglectful parents

16. A parent asks the nurse about her school age child's nutritional need
especially after school. The nurse suggests that they develop a nutritional plan
for the child keeping in mind that the child
A. should not be eating in between meals
B. will instinctively choose her nutritious snacks
C. should eat the snack the mother prepares
D. should help prepare her own snacks

Answer: D -

17. While assessing an infant, the nurse notes that the infant's anterior fontanel
is still slightly open. The nurse should
A. refer the finding to the pediatrician
B. proceed with the examination since this is normal
C. perform an extensive neurological examination
D. administer MMDST and IQ test

Answer: B
Posterior: 2-3 months
Anterior: 12-18 months

Which of the following is true when obtaining vital signs of children? Choose all
that apply
A. The most important aspect of obtaining blood pressure ls holding the child’s
extremely at the level of the heart.
B. If the respiratory rate is ebtained when the child is crying, the procedure
should be repeated
C. The radial pulse for chilären under 2 yeurs of age should be obtalned in one
full minute.
D. Lessen the child anxiety by demanstrating the procedure on a doll or stuffed toy

Answer: B,D
2 years old and below- apical pulse for more accurate result

19. A 19-year-old client had undergone abdominal surgery. As the nurse enters the
client's room, which of the following questions would she expect the client to ask
initially?
A. "Why am I experiencing pain?"
B. "Will I have a prominent scar?"
C. "Would the pain subside?"
D. "When can I go back to school?"

Answer: B

20. Which among the following behaviors is typically exhibited by a preschool

child?
A. He is upset about the scar left by a minor accident - adolescent
B. He wants to know why his male friends are not visiting.
C. He asks for a bandage after having his blood drawn
D. He cried in protest when his mother leaves. (Toddler)

Answer: C

ABCD OF PRE-SCHOOL FEARS

• Abandonment
• Body mutilation
• Castration
• Dark

21. The nurse is observing Nicole, a 10-month-old child, and her parents play.
Which statement, when made by the parents, would indicate their understanding of
their child's development of object permanence?
A. "My child looks for the toy that her father hid behind his back."
B. "My child bangs the two cubes in her hands and throws them to the floor."
C. "Nicole is able to return the doll to the same spot where her mother has taken
it."
D. "Nicole is aware that the ball of clay her father made is the same object even
when it's flattened out.

Answer: A
22. What discharge information should the nurse give to the mother of a 15-month-
old who has just received his immunization of DPT, Polio vaccine, and MMR? (Select
all that apply.)
A. Mild fever can be managed by acetaminophen
B. Minor symptoms can be treated with aspirin
C. The child should be restricted to perform his activities for the day
D. Soreness at the immunization site and mild fever are common side effects
E. The immunizations will prevent the child from contracting other related
diseases.
F. Return the child to the clinic once the child develops high fever, difficulty of
breathing, or seizures

Answer: A, D, F

23. The parents of a 5-year-old child ask the nurse for anticipatory guidance. The
nurse should explain that a child of this age:
A. still depends on the parents
B. is highly sensitive to criticism
C. rebels against scheduled activities
D. loves to tattle

Answer: D

24. The drug reference states that the recommended dose of medication for a 10-
year-old is 60 mg/kg of body weight in 24 hours. The dose for a 66-lb child would
be
A. 1500 mg every 12 hours
B. 1000 mg every 6 hours
C. 600 mg every 8 hours
D. 1800 mg every 4 hours

Answer: C

25. In order to instill ear drops into the left ear of a 4-year-old, the nurse
should
A. pull the outer ear up and toward the back of the head
B. pull the earlobe up and toward the nose
C. pull the outer ear down and toward the back of the head (3 years below)
D. the earlobe down and toward the chin

Answer: A

27. To meet the activity needs of a four-year-old, the nurse should plan to provide
which toy?
A. A colorful helium balloon
B. A brightly colored hanging mobile
C. A jigsaw puzzle of animals
D. A plastic stethoscope and syringe

Answer: D -

28. The mother of a five-year-old expresses her concern over her son's stuttering.
Which of the following responses of the nurse would be the least appropriate?
A. Look directly at your son while he is speaking.
B. Singing nursery rhymes may ease his stuttering.
C. If your son stutters, stop him and encourage him to begin the word again.
D. It is common in children younger than age seven to exhibit vocal hesitancy.
Answer: A

29. A mother asks the nurse how to determine if her baby is getting enough milk.
The nurse should tell the mother that the best way to evaluate adequate intake of
the newborn is by which of the following methods?
• Amount of crying the newborn does
• Number of wet diapers
• Frequency of spitting out or regurgitation
• Number of hours the baby sleeps after feeding
Answer: B

30. Which statement by a 14-year-old female would the nurse focus on as it may pose
a problem on her normal growth and development?
A. "My parents treat me like a baby sometimes."
B. “I'm worried about this pimple on may face. Everyone seems to notice it."
С. "I haven't gotten my period yet. All my friends have theirs."
D. "All the kids in this school don't like me. I don't like them either."

Answer: D

32. Which of the following developmental milestone would a nurse assess for a 1-
month old infant?
• turning the head from side to side - 2 months
• rolling from back to side (4 months)
• laughing out loud (4 months)
• holding a rattle briefly -

Answer: A

33. The mother of an 8-month-old infant asks the nurse what toy to provide her
child to promote the child's cognitive development. The nurse should answer
• finger paints
• jack-in-the-box
• small rubber ball
• colored jumping ropes

Answer: B

34. The parents of a 4-month old infant who is admitted to the pediatric unit for
the completion of antibiotic therapy tell the nurse that they can visit the child
only during weekends. To meet the child's emotional needs, the nurse should
• assign the infant to the same nurse as often as possible
• place the child in the unit where most toddlers are admitted
• admit the child in the isolation room away from other children
• tell the nurses in the unit to take turns in caring for the child

Answer: A

35. While observing a two-year-old client recently admitted in the unit, the nurse
should be concerned when she notices which one of the following?
• The child replies "no" to every question. (No no stage)
• The child recognizes four to six words.
• The child is not yet potty trained. (Its okay for mastery of
development)
• The child doesn't want to share her toys. (Parallel play)

Answer: B - around 30 words

36. The nurse is giving instruction to a mother who uses highchair when feeding her
toddler. The mother understood the nurse's instruction when she says that after
placing the child in the chair, she initially performs what action?
• Cut the child's food into bite size pieces
• Pour a small amount of milk into the glass
• Secure the child with the chair belt
• Do not hurry the child to finish his food

Answer: C - safety or prevent fall

37. Alice, 11 years old, is to undergo a major surgical procedure. Her parents had
been informed of the surgical benefits and risks and were asked to sign the consent
form. The nurse understands that informed consent is based on the ethical principle
of
• Justice and legal obligation
• Veracity and nonmaleficence
• Paternalism and fidelity
• Autonomy and beneficence

Answer: D

38.
Anthony 9 years old is brought by his mother for preoperative interview. Anthony's
mother is requesting the nurse to prepare her child. The child was hospitalized
last year due to a fractured right arm last year and is to undergo tonsillectomy in
three days. Anthony's mother is requesting the nurse to prepare her child for the
upcoming hospitalization. Which of the following actions of the nurse would best
meet the child's needs for preparation?
• Tell the child that the upcoming hospitalization is quite similar
with his past hospitalization.
• Assure the child that he would be admitted only to have his throat
checked.
• Tell the child stories of other children who had the same operation.
• Suggest a role play and provide materials to the child

Answer: D

39. A 5-year-old client who was given pain medication before bedtime got out of bed
during the night and fell, sustaining a laceration that requires suturing. Which
statement would be included in the nurse's documentation in the client's chart?
• "Client fell due to confusion as a side effect of the pain
medication given at 8 PM."
• "Client found sitting on the floor with a 3 cm. laceration above
right eyebrow. Oriented to name only."
• “The client was seen unconscious on the floor in a pool of blood. Nurse
Attendants forgot to put the side rails up at bedtime”
• Client slipped in the water on the floor caused by a leak from the
unit's ceiling. Informed maintenance department about the leak
• 2 days ago

Answer: B - objective
do not attend to pin down anybody to save others

40. A n infant who weighs 8.5 kgs has a caloric requirement of 120 cal/kg/24 hours.
The formula milk prescribed for this infant has 20 cal in 2 ounces. The nurse
understands that the infant would need how many cc in a 24-hour period?
A. 103
B. 106
C. 1020
D. 3060

Answer: D
120 x 8.5 / 20 ???